Provider First Line Business Practice Location Address:
2635 WOOLSEY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BERKELEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-549-0776
Provider Business Practice Location Address Fax Number:
510-549-9845
Provider Enumeration Date:
10/16/2006